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Neuro Block 4 > Stroke Active Learning > Flashcards

Stroke Active Learning Flashcards

1
Q

What is a stroke?

A

a sudden onset focal CNS deficit due to vascular cause

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2
Q

WHat is a TIA?

A

It’s a TRANSIENT neurologic dysfunction without evidence for cerebral infarct

it’s caused by focal brain, spinal cord, or retinal ischemia wihtout acute infarction

NO PERMANENT TISSUE DAMAGE

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3
Q

What is the difference between a TIA and a TSI?

A

A TSI is transient symptoms with infarction

So patients have symptoms that totally resolve, but they have a lesion on MRI - so basically a damaging stroke with no permanent effects

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4
Q

What are the two types of stroke? Which is more common?

A

hemorrhagic and ischemic (most common)

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5
Q

What are the vast majority of strokes caused by in the US?

A

atherosclerotic disease

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6
Q

What happens in an ischemic stroke?

A

a direct thrombosis or embolism from another source occludes a cerebral vessel, cutting off oxygen supply to the regions supplied by the vessel, leading to neuronal death and neurological deficit

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7
Q

How long does it take for neurons to start dying after osygen is cut off?

A

only 4 minutes

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8
Q

What are some other causes of ischemic stroke besides atheroscleotic disease? In what group are these most common?

A

vasculitis, sickle cell crisis, severe preeclampsia, vertebral or carotid artery dissection, complicated migraine with vasospasm, sympathomimetic induced vasospasm from drug use like cocaine or amphetamines

adults younger then 45 years of age

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9
Q

How can ischemic strokes be further classified?

A

large vessel or small vessel

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10
Q

What vessels are most often affected in anterior circulation? Posterior circulation?

A

anterior: 1. common carotid 2. MCA 3. ACA
posterior: 1. vertebral artery 2. basilar artery 3. PCA

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11
Q

What vessels are affected in smal vessel ischemic stroke and what’s the term for these strokes?

A

the penetrating arteries

called lacunar stroke

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12
Q

What past medical history factor is very much associated with lacunar stroke?

A

HTN

it induces endotheliual damage, such that the penetrating arteries have an increased risk of bleeding and clot formation

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13
Q

What is the difference between intracerebral stroke and subarachnoid hemorrhage morphologically?

A

intracerebral stroke is bleeding into the brain itself

subarachnoid hemorrhage is bleeding into the space between the arachnoid and the pia

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14
Q

How do intracerebral stroke and subarachnoid hemorrhage differ symptomatically?

A

intracerebral stroke involves sudden focal neurological deficits but no real headache

Subarachnoid hemorrhage includes thunderclap headache, LOC, focal neuro findings, nausea, vomiting, photophobia, nuchal rigidity, etc.

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15
Q

What percentage of strokes are intracerebral hemorrhage?

A

13%

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16
Q

What are the risk factors for intracerebral hemorrhage?

A

increasing age

male

HTN

EtOH

tobacco

diabetes

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17
Q

How do you diagnose a hemorrhagic stroke?

A

head CT

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18
Q

What is the current management for intracranial hemorrhage?

A
  1. STOP or reverse anticoagulants if they’r eon them
  2. surgical removal of clots may improve outcomes
  3. lowering BP maybe contribute to improved fucntion in survivors
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19
Q

What are subarachnoid hemorrhages usually caused by?

A

trauma and shear forces that tear the perforating vessels feeding the underlying ocrtex

more common in elderly because their brains have shrunk a bit

20
Q

What is the most common NON-TRAUMATIC cause of subarachnoid hemorrhage?

A

ruptured berry aneurysm

21
Q

What are the demographics of berry aneurysm rupture?

A

mean age 55

50% mroe common in men

blacks twice as often as whites

22
Q

What is a symptom that can warn of a berry aneurysm?

A

sentinel headaches - during exercise or sex

23
Q

If a head CT is inconclusive but you have high suscpicion for a subarachnoid hemorrhage, what other diagnostic test can you do?

A

do an LP and look for blood in the CSF

24
Q

What drug can you give for SAH management?

A

Nimodipine

it’s a Ca2+ channel blocker that preferentially affects the CNS
we think it works to dilate small vessels to increase collateral circulation and preserve cerebral perfusion in the event of massive bleeding

25
Q

What are the surgical options for a berry aneurysm that hasn’t ruptured yet?

A

clipping or endovascular coiling

both have risk though, so you can consider watching a patient with serial imaging to see any growth or change in the aneurysm

26
Q

True or false, SAH is associated with recurrent headaches or recent use of NSAIDs

A

false

27
Q

In general, what to strokes of the anterior circulation cause?

A

contralateral weakness and sensory deficits

28
Q

What symptoms will result from an MCA stroke?

A
  1. motor and sensory deficits in the face and arms
  2. a homonymous hemianopsia with ipsilateral gaze deviation (looking at their lesion)
29
Q

Strokes of the dominant cerebral hemisphere will produce what? How about the nondominant?

A

dominant = usually left = aphasia

nondominant = usually right = contralateral hemineglect

30
Q

What will the symptoms of an anterior cerebral artery stroke be?

A
  1. motor and sensory loss in the contralateral leg
  2. personality changes and other frontal lobe issues
  3. blindness in the ipsilateral eye (since opghlamic artery comes off the ACA)
31
Q

What will you get in stroke of the vertebral artery?

A

you get cerebellar dysfunction, with symptoms of vertigo, blurred vision, vomiting, nystagmus, ataxia, and postural isntability

also lateral medullary infarct with numbness on the right side of the face, but left side of the body

32
Q

What’s another name for the lateral medullary infarct causing cross sensory symptoms?

A

Wallenberg syndrome

33
Q

What symptoms will you see wiht a basilar artery stroke?

A

cranial nerve palsies

34
Q

What are the mortality rates for basilar artery stroke?

A

really bad - 90% die

35
Q

What symptoms will a patient have in a posterior cerebral artery stroke?

A

visual problems - contralateral field loss with macular sparing

36
Q

Where will a stroke be if you have pure motor symptoms? Pure sensory symptoms?

(note that these are lacunar strokes)

A

motor = internal capsule

sensory - thalamus

37
Q

Why is asking about when a patient was last seen normal so important?

A

because if they first began experiencing symptoms less than 4/5 horus ago, they may be candicates for TPN (Fibrinolytic therapy)

38
Q

Why should you do a rectal exam i fyou’re thinking about giving TPN?

A

TPN will make you bleed, so if you already have a GI bleed, that would be bad news

39
Q

What are some other labs and tests you might do for someon who presents with potential stroke?

A

CB, BPM. Hepatic progiel, lipid profile, INR

EKG, Telemetry, Carotid doppler, echocardiogram

40
Q

How soon should patients start taking aspirin after experiencing an ischemic stroke or TIA?

A

witin 24 to 48 hours, but not before

41
Q

What drug can be used in an aspirin allergy?

A

clopidogrel

42
Q

What should you do with someone’s blood pressure immediatley after a stroke?

A

it will probably be high and you should leave it there!

The higher pressure will mean the brain regions that have been cut off will be perfused

43
Q

If someone has a stroke associated with moderate to severe carotid artery disease, what prodecure iwll reduce the risk or recurrent stroke?

A

carotid endarterectomy

44
Q

What drugs will you initiate for someone diagnosed with Afib?

A

anticoagulants - afib causes the blood to pool and more likely to clot

45
Q
A

Neuro Block 4 (20 decks)

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